Tag: SRE

This week, artist Laura Dodsworth’s latest piece hit the news. This is a collection of photographs of 100 vulvas. One of the reasons this is great is that it taps into and challenges taboos around vulval genitalia. One of the misconceptions very publicly elicited was the language and terms use- Dodsworth correctly uses ‘vulva’ to refer to the externally visible parts of this type of genitalia:

That ignorance around this exists became very evident, very quickly. One twitterer tried to ‘correct’ it. I’m doing so, he used the term ‘vagina’ which, although a common mistake, refers to the passage between the cervix (entrance of the womb) and outside of the body. These bits can be photographed, but it’s rather tricky and involves specialist equipment!

Rounding off the year, let’s have a look at penises! We (the societal ‘we’) tend to be a bit more familiar with the constituent parts than we are with vulvas…

Glans: This is the tip or ‘head’ of the penis.

Foreskin: This is a fold of skin that covers the glans of the penis. It can be removed, either at birth or later in life, for either medical or cultural reasons in a process called circumcision. Rates of this practice vary across the world and it isn’t as common in the UK as in other parts of the world.

Urethra: The opening of the penis. Semen, urine and discharge can leave the body here. As with discharge from the vagina, this can be normal. Changes in the discharge (e.g. smell or colour), especially when accompanied by other symptoms (pain, itchiness) can however indicate something’s not quite right and might need checking out.

Shaft: This is the main bit of the penis. Internally are found the tubes that carry urine and semen out of the body, as well as blood vessels supplying the penis – this is part of the mechanism that causes the penis to become hard and bigger during an erection.

The average penis size is 9 cm when not erect, although there is a fairly large and health variation in this.

The information here is adapted from an exercise from Sexplain UK, used as part of their SRE lessons. In short, it involves using play dough to build genitals. This exercise can be used to teach people about external genitalia (both penises and vulvas). As an arts and crafts activity, it can be fun and engaging and help to give something concrete to talk around in terms of things like physiology, variation and health. I have also included the recipe I use for homemade play dough.

To make your dough.

Ingredients:

2 cups plain flour

1 cup of salt

2 teaspoons cream of tartar

1 tablespoon of vegetable oil

2 cups of boiling water

Something to colour the dough with (optional) such as food dye, paint powder, or a crushed soft pastel

Instructions:

Put all of the ingredients except for the water and colouring in to a large mixing bowl. Boil water and add this to the mix whilst still very hot. Mix immediately using a wooden spoon. Once the mixture is cool enough to handle, put some flour on a surface and lightly knead the mixture for a short time. If you are adding colouring, now knead this in until the dough is roughly all the same shade throughout.

Make sure the dough is left uncovered until it is cool, then cover in an airtight container. It should last for about a week. This recipe makes enough for about twelve people if doing the exercise below.

Vulva models made from play dough recipe

So, all foetuses have the same general genital structures, regardless of what sex they will become. They then typically (but not always) differentiate in to either a penis or vulva. These are the external genitalia (i.e. the bits you can see).

We’ll look at vulva first, as this is the one people tend to find a bit trickier.

Take your ball of play dough and divide it in to four pieces. With one of these quarters, make a left or diamond shape:

This is the vestibule of the vulva.

Next, take another quarter and roll it in to a sausage shape, about the length of one side of the vestibule and attach it to one side:

This is the labia majora, the fatty tissue that covers the whole vulva and tends to be covered in hair after puberty. Complete it by making another sausage to attach to the other side:

Next, divide the last quarter in to two. With one piece, make a smaller sausage to attach inside one side of the labia majora. This can be flattened if you like:

This is the labia minora. In about half of people with vulvas, the ‘inner lips’ of the labia minora sit outside of the bigger ‘outer lips’ of the labia majora. Let’s complete these. As with the labia majora, it’s not a problem if they aren’t exactly symmetrical:

Next, let’s make a very important structure: the clitoris. Either take a little ball of extra dough, or pinch a piece off from your existing structure:

The bit we can see here only represents the external part – it extends to be a much bigger structure internally. The clitoris is made of very sensitive tissue, with lots of nerve fibres. Some people find it arousing or stimulating when touched gently.

To complete, let’s make the ‘holes’ in the vulva. Get people to guess how many ‘holes’ the vulva contains (guesses I’ve heard range from one to twenty!). For this model, we’ll be looking at two (you can explain that some people talk about a third, the anus, which is actually outside/below the vulva). The first is about a third of the way down and can be marked with a finger or a pencil:

Get students to guess its name – the urethra, and it’s function – carries urine away from the body. It is separate from the next hole we’re going to make. This hole is nearer the bottom of the vestibule and can be marked by making a hole all the way through:

Again, you can get people to guess the name (vagina) and point out that this is the name people often use (incorrectly) to refer to the vulva. You can talk about things that come out of the vagina – i.e. blood (periods), babies and discharge (either healthy or a sign of otherwise, such as thrush or bacteria).

Next, we’ll make a model of a penis.

This time, divide the dough in to two pieces. With the first piece, make a sausage shape:

This represents the shaft of the penis. We can then make a little distinct area by marking out the end:

This is the glands of the penis, which tends to be more sensitive than the shaft. Next we can make a hole in the end (with a pencil or finger). This is the urethra or the penis. Three things can come out of this – urine, ejaculation or discharge.

Give people the option of making a foreskin – pinch off a little bit of dough and fashion in to a thin rectangle to cover the glans. This is a good point to talk about hygiene – e.g. washing with water and changes during puberty, as well as circumcision.

Next, we’ll finish off with making the testicles (scrotum). There is a good chance that students will already have made them with the other half of the dough by making two balls and attaching these to the base of the penis:

This is fine and validate this. Also explain that you can make them from a ‘teardrop’ shape and attach that. You can talk about the misconception that ‘balls drop’ (i.e. they get bigger and hang lower after puberty, but don’t actually ‘drop’ further out of the body).

It can be a nice idea to get the students to look at and reflect on how different all of the bits are. Lots of them seem to ask what ‘normal’ is – this can be a good place to point out that this is something that is highly individual.

We often talk (briefly) about the concept of it being possible to be biologically ‘intersex’ – i.e. it is possible to have someone who doesn’t have external genitalia that fall neatly in to either of these categories.

It can also lead on nicely to talking about internal genitalia and reproductive functions.

Every now and then I see an image of a penis whilst out and about. Various public places lend themselves particularly to this, such as the back of loo doors or bus seats. I bet you know exactly what it looks like. In fact, you’re probably picturing what it looks like now, a sausage shape with two circles for testicles. If the artist is paying particular attention to detail, you might get some strands of hair sticking out of them, or some ejaculate coming out of the top.

As yet, I’ve never seen a vulva presented in quite the same way. Occasionally they are seen as a piece of more formally displayed art – The Vulva Gallery is my current favourite maker and curator of such images. Why is this? Is it the different social-cultural meaning that the different genitalia have? Or maybe it’s just not being quite sure what to draw.

With this in mind, here’s my step-by-step guide to drawing vulvas. I’m not encouraging you to draw on public property, but I’m wishing that more people could.

First, draw a leaf- type shape.

This is the vestibule, the smooth bit that is usually covered by the labia.

Next, draw two ‘lips’ either side like so:

These are the labia majora, the fatty pads of tissue that surround the vulva. If you like, hair can be added here. They often cover the rest of the bits that we’re going to draw, but which are still external.

Let’s add a bit more detail. We now need to make two more ‘inner lips’, of the labia minora.

These can be either hanging out beyond the labia majora, or can nestle within. When people (incorrectly) talk about a ‘vaginoplasty’ or ‘designer vagina’ they are often referring to labiaplasty , or surgical reduction of this area.

We now need to start adding some detail. First, let’s add a little round circle. Let’s go wild and make it red.

This represents, you’ve guessed it – the clitoris. Or at least the bit of the clitoris that can be seen externally. There are a lot of misconceptions about the clitoris. Suffice to say, the bit that you can see here represents just a small part of the total structure of the clitoris. It is a sensitive area, which contains millions of nerve endings and is often overlooked because its main purpose seems to be sensual with no conventional reproductive function.

Moving on to another often over looked area of the vulva is the first of the two ‘openings’ in to the internal part of the body, the urethra. Let’s draw another small circle in the vestibule to represent the area where urine comes out, running straight from the ‘storage’ area of the bladder:

An important point to note is that this is a separate and distinct area from the vagina. Urine comes out of this. Babies, periods and discharge from infections of the internal reproductive tract do not. They come from the second ‘hole’ in the vestibule, the vagina. Of course, in real life it isn’t a hole that maintains itself and is ‘squashy’, although can accomodate being made larger – e.g. by neonates’ heads, tampons or penises, for example:

So if it’s a bigger than this, or more squashy, that’s spot on.

You can stop here. Because it’s often overlooked, I’m going to add some remnants of the hymenal tissue. Note that in health, this is not a complete covering or seal.

Voila! And remember – this is only a schematic. Vulvas you have seen may look completely different from this AND THAT IS ABSOLUTELY FINE.

I joined the lovely voluntary organisation Sexplain (‘Bringing sexual and relationship education into the 21st Century’) as a volunteer facilitator based on two things. The first was an array of terrible personal experiences of Sex Ed over two decades ago during my time at school. The second was professional surprise at how little people (particularly those with vulvas!) appeared to know about the intimate parts of their own bodies when I started working on a Gynaecology ward.

One of the things that I found a little unrelenting about my own school SRE learning experiences was how much the emphasis around sex was ‘not getting pregnant’. It’s all very well to encourage and teach healthy sexual practices. However, I feel the message went beyond this. In my classroom, romantic intimacy amounted to sex and sex meant penetrative, penis-in-vagina sex only. Pleasure, consent and masturbation were not on the curriculum. Sex was problematic, dangerous, risky – never ‘fun’ or ‘fulfilling’. The ultimate hazard was pregnancy and STIs. Nothing good could come out of sex but if for some reason you found yourself having it, the ultimate consideration was to NOT GET PREGNANT.

It turns out that this world view prepared us badly for adult reality. We learnt how effective a condom was versus a diaphragm, but not how to procure or negotiate the use of either. We learnt that STIs cause discharge from orifices that we had only a crude understanding of.

Another classroom illusion that was challenged, by both my personal life and professional experience, was that there is a ‘perfect’ choice of contraception for each person. For many, contraception can be a compromise, a ‘best match’, or a pragmatic move. It can take in to account what you feel able to negotiate with a sexual partner. Or what you can afford or have the time and resources to obtain. Or choosing something you feel is a bit shoddy, but doesn’t leave you with the terrible side-effects of some methods.

I created ‘contraception top trumps’ because I wanted to look at contraception not as a set of absolutely rational, clear-cut decisions (you fulfil criteria x so you should use y) but as a work in progress. You can learn about and develop an approach to contraception, depending on what is important to you… and unfortunately there’s an element of luck to the whole thing.

I’ve published a printable pdf of contraception top trumps – I would advise printing four pages to an A4 sheet for large print cards and eight for more portable ones!

The link above is for a smartened up and downloadable version of the top trumps game I published earlier this year here on this blog. One of the lovely things about doing this was the interesting and open conversations this prompted with friends. For example -the one person who confessed she’d had a blazing row with her GP about removing the hormonal implant because she couldn’t cope with the emotional changes that came once it was fitted and had been told simply to ‘persevere’. Or the friend informed that they couldn’t have the copper coil fitted because ‘she hadn’t had children’. Or the disbelieving faces that meet you when you look at failure rates of condoms, many peoples’ go-to! Please download, play, share and learn these with whoever you can and start your own conversations.

My estimate of 20% effectiveness from ‘a wing and a prayer’ was based on a statistic I saw that said 80% of couples having sex regularly would conceive within one year. So it’s probably a bit low for one single instance of sex. However, I can’t for the life of me find that and the current online NHS advice on infertility suggests that 84% of such couples would conceive within a year, suggesting a figure of 16%. Either way, it’s not a great method and is incredibly less reliable than actively doing something. I just wanted to show that it was not guaranteed that you would get pregnant every time you had sex, even once, which is definitely the impression that I got from Miss Hargreaves in Year 9…

I’m on holiday abroad at the moment. It’s got me thinking about cultural norms and attitudes to various things, including nudity and attitudes towards sex.

The more I meet and talk to people from outside of my own country, the more I reflect on our own general national attitudes. It’s inherently difficult to get an unbiased and honestly reflective impression of yourself. With that caveat, it seems to me to be evident that in the UK we are a little more uncomfortable talking about sex. Whenever I travel I seem to see a wealth of examples of people being generally more at ease with their bodies. From the presence of wrinkly, black bikini-clad Nonnas on Italian beaches, to the communal changing rooms in Japanese Onsen.

I’ll be taking a few souvenirs back with me to London. Above are some I’d like to share with you: various types of nudes from the Montreal Musée des Beux-Arts. Enjoy!

My weakest area at med school was definitely anatomy. I enjoyed it though. Each week, we would go to the anatomy suite where the cadavers were kept and I would learn another thing I was previously mistaken about. The relationship between what we see and understand on the outside and what and where it is on the inside is often not straightforward.

The stomach, for example, is not the low down bit of the abdomen people hold when they have ‘bellyache’ – that’s more like bowels. This is part of the gut, but with has a distinct and different function. What a lot of people think of as the ‘vagina’ (the passage from the external body to the womb) would actually be better described as the ‘vulva’. In my experience, these misconceptions are rife in ideas about our reproductive organs. Let’s have a look at some of the internal xx anatomy…

Vagina: a passage leading from the outside to internal parts. It’s made up of muscular, stretchy tissue that can deform and accommodate various things (tampons, fingers, foreign objects, a baby…).

Cervix: the lower bit of the womb. Roughly tube shaped and typically around 2-3cm long. It has a hole (the cervical ‘os’) which leads from the vagina to the womb. It can change shape, size and consistency under hormonal control – e.g. getting smaller and opening during childbirth.

Uterus: Or ‘womb’. This is where a baby can grow. Sits just behind the bladder in non-pregnancy. The lining of this cavity is called the ‘endometrium’. It is the endometrium thickening and then shedding that is experienced as periods. The top bit of the uterus is called the ‘fundus’.

Fallopian tubes: connect the uterus to the ovaries. Also called the ‘salpinges’ or a ‘salpinx’. Each one ends in a ‘fimbria’. This is a little fringe of tissue that helps convey eggs in to the tubes from the ovaries.

Ovaries: whitish lumps of tissue where eggs are released from. They also produce hormones so have an important endocrine role.

All of these structures sit quite low down in the abdomen. Sometimes problems that feel like they are coming from this reproductive tract can be mistaken for problems with the bowel and vice versa. We’ll have a look at some of these problems another time…

A friend of a friend reckons reports that as a child they were told that babies were made by ‘mummy and daddy having a very special hug’. Subsequently they were terrified every time their grandparents tried to hug them, convinced that this would leave them impregnated!

Genitals. Everyone has them. Sometimes they have weird and wonderful bits. Do you know where to find a raphe of a penis? How about the bartholin’s glands? Occasionally we don’t seem to know how to use them, or what they are for. Sometimes they go wrong. Ever feel like we should be handed a manual? You know – ‘Genitals: A User’s Guide.’ Maybe it could be issued sometime before puberty. That’s what I’d like to create over the next few months – ‘Genital’s: A User’s Manual’. With words and pictures.

Let’s start with the basics. The external genitalia. For a lot of people there are two basic flavours: the penis ( and it’s sidekick the scrotum or testicles) or the vulva get up. Note that I don’t (and won’t) use the words ‘male’ and ‘female’ to delineate these two. Chromosomal and genetic sex is separate from gender identity – people of both and any gender can have either genitalia. Also, it is possible for people to be born with genitalia that do not fit in to this penis/ vagina divide – again, more on that later.

We tend to be pretty familiar with the basic components of penises – the pole and two balls, depicted for generations on the walls of public loos. A little more mysterious seems to be the vulva. People often refer to this as a ‘vagina’. Technically though, vagina is the name for the hole bit – the bit that connects the outside world to the inside (more detail on that next week). The vulva is the word used to describe all of the external parts.

Here are a very small collection of words that we use for genitals in English. I think it’s important to have the vocabulary to describe genitals if we’re going to talk about them in more detail. Enjoy – and let me know (@SquiSquaSque) if you’ve got any favourite words for ‘down there’ that I haven’t included.

My friend M and I were reminiscing about the ‘Just-17’ magazine era of our lives recently. I say ‘reminiscing’, but ‘looking back with discomfort and some introspection’ might be more apt. We had just attended a volunteer training day with the lovely people at Sexplain – an organisation that provides inclusive sex education. As part of this, we had been asked to reflect on messages we had picked up about sex when we were younger. M and I went to school together in the 90s. This was when the likes of Bliss, Sugar and Cosmo-Girl were the height of sophistication for an adolescent girl. Contained within their pages were a mixture of fashion, make-up tips, celebrity gossip and relationship advice – with the edgier ones including advice on ACTUAL SEX. They often came with free lip gloss.

Ostensibly, sounds great – a place to get informal and confidential information on sex. However sometimes the tone and implicit assumptions of these magazines were what I would now describe as ‘problematic’. There was very much a dominant, heteronormative view of relationships. There was an implicit assumption – within advice pieces on how to give a good blow-job, for example – that being anything other than straight just wasn’t an option. Advice on how to deal with your boyfriend came in many guises, but never what to do if you might want a girlfriend, or something else. Sex was defined very narrowly as penis-in-vagina penetrative sex. In addition, the endless parade of smiling, white, stick-thin celebrities and models did nothing good for my self-esteem. All of that said, before the unfettered internet access of today, this was one of the few places that talked about sex. Every week. With an opportunity to write in and ask anonymous questions.

I used to buy the magazine during my trips accompanying my Mum to the supermarket on a Saturday. I was interested in them from the ages of about 11 – 14 years (i.e. a fair while before I was going to have sex). There was a real gap of sources of information for curious teenagers wanting to know more about sex and relationships. Even if they didn’t do it as deftly as you might hope, they did fill a niche in a way other sources didn’t. Sex Ed classes at school were too staid and delivered by a deeply out of reach authority figure. My parents were well meaning, but I think honestly relieved to just get over ‘the talk’. My friends generally knew as little as I did.

As I’ve said, I was reading the likes of Just-17, Bliss, Sugar, and Cosmo-girl well before I was actually having sex. By thta time the internet had come along and I could rely on a dubious combination of the world wide web and rumours spread amongst my (now slightly more experienced) peers. The magazines I remember are now defunct, having died along with much of print media. Teen Vogue, established in 2003, seems to be the contemporary thing anything like the mags of my youth. Thankfully, it is somewhat different in content as well as form (online only since 2017). It contains a ‘news and politics’ section. It is queer friendly and controversial with it – it first came to my attention during the furore over their publication of an anal sex guide. I thought a guide to bra fittings was pretty revolutionary in my adolescence – this puts it in to a whole different perspective. And in an age of sexting, online grooming and internet pornography ‘desensitising’, I see this as a hugely welcome step. Technology it seems has opened the flood gates on some pretty scary things, but also allowed in a new perspective on sex and relationships. And I never really liked the lip balm anyway…